Provider Demographics
NPI:1164049896
Name:DIMINICK, CONNER CHRISTIAN (DMD)
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:CHRISTIAN
Last Name:DIMINICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SUMMIT DR APT 224
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1163
Mailing Address - Country:US
Mailing Address - Phone:717-405-1590
Mailing Address - Fax:
Practice Address - Street 1:1013 W MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-9699
Practice Address - Country:US
Practice Address - Phone:717-653-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice